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World J Diabetes. Aug 15, 2025; 16(8): 107733
Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.107733
Digital health for rural diabetes care: Implementation experience from China and India
Alon Rasooly, David Beran, Peng-Peng Ye, Surabhi Joshi, Xue-Jun Yin, Nikhil Tandon, Rui-Tai Shao
Alon Rasooly, Department of Health Policy and Systems Management, School of Public Health, Ben-Gurion University, Beersheba 8410501, Israel
David Beran, Division of Tropical and Humanitarian Medicine, Faculty of Medicine, University of Geneva and Geneva University Hospitals, Geneva CH-1211, Switzerland
Peng-Peng Ye, National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
Surabhi Joshi, Department of Noncommunicable Diseases, Disability and Rehabilitation, The World Health Organization, Geneva 1211, Switzerland
Xue-Jun Yin, School of Public Health, Jiangxi Medical College, Nanchang University, Nanchang 330006, Jiangxi Province, China
Xue-Jun Yin, Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Nanchang University, Nanchang 330006, Jiangxi Province, China
Nikhil Tandon, Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Rui-Tai Shao, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
Author contributions: Rasooly A and Beran D contributed to conceptualization and study design; Shao RT and Tandon N contributed to subject matter expertise and critical interpretation of health systems in China and India, respectively; Ye PP and Yin XJ contributed to data curation and interpretation of Chinese digital health interventions; Joshi S contributed to analysis of Indian healthcare context and integration of global digital health frameworks; Rasooly A contributed to writing - original draft; All authors contributed to writing - review and editing, validation of intellectual content, and final approval of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this publication.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alon Rasooly, MD, PhD, Department of Health Policy and Systems Management, School of Public Health, Ben-Gurion University, David Ben-Gurion Blvd 1, Beersheba 8410501, Israel. rasooly@post.bgu.ac.il
Received: March 28, 2025
Revised: May 14, 2025
Accepted: June 27, 2025
Published online: August 15, 2025
Processing time: 139 Days and 4.2 Hours
Abstract

Diabetes affects an estimated 828 million people globally, with approximately 44% living in China and India. Rural residents with diabetes in these countries face significant challenges in access to care. Although digital health interventions are increasingly used to reach underserved populations, considerable knowledge gaps exist. This mini-review presents the first comparative analysis of digital health implementations for diabetes care in rural China and India, comprising clinical decision support tools, telemedicine, and mobile health applications. The review examines how their distinct health system structures influence technology adoption and clinical outcomes. China's hierarchical administrative structure facilitates standardized nationwide platforms with consistent protocols, while India's federal system enables diverse localized innovations that accommodate regional diversity. Cluster-randomized trials for digital health tools in rural China show significant improvements in glycemic control. In India, interventions examined in this review were associated with improved health behaviors and medication adherence. Both countries demonstrate that digital interventions leveraging existing social structures and co-created with stakeholders yield better outcomes than standard care approaches. This analysis provides actionable insights for policymakers globally while identifying valuable opportunities for knowledge exchange between these two nations that together are home to nearly half of all people living with diabetes worldwide.

Keywords: Diabetes; Rural healthcare; Digital health; China; India; Task-sharing; Co-creation

Core Tip: This mini-review examines how contrasting health system structures in China and India shape digital health implementation for rural diabetes care. While China's centralized approach enables uniform national platforms, India's decentralized system fosters adaptable local innovations. Digital interventions show clinical effectiveness when they complement existing healthcare structures, leverage community resources, and address contextual barriers. Co-creation involving people living with diabetes, primary healthcare providers, and local health administrators emerges as a critical success factor for intervention design and implementation. Future digital health investments should prioritize rural communities, participatory design processes, and sustainable implementation models to transform diabetes care for underserved communities worldwide.